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Lobb in Cerci teation (29 CFR Part 9�
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<br />e report entity, payment or agreement to make payment to
<br />closure forth shall be completed by tli p whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal Acton,
<br />This disclosure agency, a Member bf Congress, an officer or employee of Congress, or he
<br />or i material change to a previous filing, pursuant to title 31 Ll,�,C. section 1352: The filing of a form is required for each paYm
<br />any material
<br />entity for influencing or attempting to influence an officer or employee of any ag y' Continuation Sheet for additionalda ce published by the Office of
<br />employee of a Member of Congers in° connection with a covered Federal action. Use the .S A .
<br />form is inadequate. Complete all item infoisinationor both the initial filing and material change report. Refer to the implementing gtu P covered Federal
<br />Management and Budget for additional
<br />1 • Identify the typd of covered Federal action for which lobbying aeti9k is and/or has been secured to influence the outcamc o, a
<br />action,
<br />2. Identify the status of the covered. Federal action.
<br />' which the change occurred. Enter the date of the last previously submitted report by this reporting entity
<br />3. Identify the appropriate classification of this report. if this is a followup report caused by a material change to the information previous y
<br />reported, enter the year and quarte
<br />for this covered' Federal action. appropriate
<br />Enter the full name, address, city, state and zip code df the reporting entity. Include Congr
<br />essional District, if known. Check the
<br />4,
<br />rime is the 1st tier, Subawards include but are not limited tp subcontracts, subgrants and contract awards under
<br />classification of the reporting entity that designates if it is, or expects to be, a prime or'subaward recipient. Identify the tier of the su ewer nd
<br />e.g., the first subawardee of the p
<br />grants.
<br />5
<br />If the organization filing the report m item f checks °subawardee ", than enter the full name, address, city, state and zip code of the prime Federal
<br />recipient, Include Congressional District, i
<br />6. Enter the name.of the Federal agency making
<br />s othe award or loan
<br />States Coast Guard. etude at least one orgariizztional level below agency name, if
<br />known.' For example, Department•of Trap p
<br />Enter the Federal program name or description for the covered Federal action (item 1). If known, toter the full Catalog of Federal Domestic
<br />7. Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.
<br />Request for Proposal (RFP)
<br />S. ' grant announcement number, the contract gent, or loan award number, the appllcation/proposai
<br />Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 e.g:, q
<br />number; invitation for Bid (IFB) number, gra IRFP- DE-g0- 001."
<br />control number assigned by the Federal agency), include prefixes, . 9 ,'
<br />q For a covered Federal action wherein ere as been an in item 4 or 5. rmmtment by the Federal agency, enter the Federal amount of the
<br />award/loan commitment for the prime entity the to orting entity identified in item 4 to
<br />Enter the full name, address, city; s
<br />10. (a) tate and Zip code of the lobbying entity engaged by P
<br />influence the covered Federal action. Enter Last
<br />(b) Enter the foil names e aodt the Individual(i) idual() ) rforming services, and Include full address !f different from i0 {a).
<br />Name, First Nam ,
<br />tanned Check all boxes that apply. If this is a
<br />11. Eater the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity em
<br />10 }. ' Indicate whether the payfnent has been made (actual) or will be made (p )•
<br />material change report , enter the cumulative amount of payment made or planned to be made.
<br />12. Check the appropriate boxes }. Check all boxes that apply: It payment Is made through an in kind contribution, specify the nature
<br />and value of the in -kind payment.
<br />Check all boxes that apply. If other, specify nature..
<br />13. Check the appropriate box(es).
<br />14, Provide a specific and detailed description code all preparatory services
<br />andtretlated activity, not Just time e(s), r actual
<br />em 1econtact rf 9 Federal
<br />that hwere
<br />date(s) of any services rendered, in
<br />officials, Identify the Federal officials) or employees) contacted or the officor(s), employ ( ,
<br />contacted.
<br />15. Check whether or riot a SF -LLL -A Continuation Sheets) is attached.
<br />1 g, The certifying official shall sign and date the form, print hislher name, title, and telephone number. time for reviewing Instructions,
<br />hering and maintaining the data needed, oalnformiation, incuding suggestionis to
<br />educing thislburdenno the
<br />rF reporting burden for this collection of Information is estimated to average 30 minutes per response, Inc u ng hing exisling data souceslat ents regarding the burden estimate or any other aspect of this of Management and Budget, Paperwork Reduction ProJect.(0348- 0046), Washington, Q.C. 20503.
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